What's the future going to be like for psychiatric medicine?What I think is that we understand too little about existing drugs - why sometimes it work, and sometimes it does not, how it actually work, how do we know it actually works, etc, etc.I hope that in the future, psychiatry is going to be more like conventional medicine (eg. cancer) in the sense that one can physically see and measure the internal effect of a drug or the internal state of a patient. For psychiatry to be more like a science, you will need clinical tools to observe, scan and measure the brain state, the nervous system, etc. If you are saying that a certain drug can increase seronotin level in the system, then there ought to be a clinical way to measure the level of seronotin in a patient so that we know if the drug is really working well on a patient. If you are saying that a certain drug can balance the state of the brain, then there ought to be a clinical way to observe such in the brain.

Psychiatric illness is destroying the life of many, not just the patients but that of their families as well.. It is destroying mine, having to cope with my wife's condition for the past 8 years or so.. and but I have to hang on, for my son's sake.Sometimes I wish I can bring myself and my family into a time machine, and fast forward 100 years into the future - maybe a real cure would be around by then.But right now, though the state of psychiatry is certainly much better than some decades ago, we are pretty much still in the dark age.

You have brought up very important and valid points about the large, only partly understood vistas of scientific knowledge regarding pathogenesis, diagnosis, measurement and treatment of psychiatric disorders that remain to be fully explored and understood. Believe it or not, we have progressed immensely when looking at how psychiatry adheres much more strongly to scientific principles, as compared with only four decades ago. Yet, there is much to be learned. We are in fact beginning to be able to measure the activity in the brain in terms of how much metabolic activity it is engaged in by specific region, when performing very specific tasks or when underpinning specific emotional or cognitive states. This has allowed us to understand which brain pathways and regions are associated with specific functions of the brain.

Thank you for drawing our attention to the budding state of psychiatric scientific certainty.

Actually, psychiatric medicine may be more advanced than you might think, already. For example, there are genetic tests now to indicate how quickly someone might metabolize a particular type of medication. It gives information that can be used to not only select a particular medication but also how much of a particular medication someone might need.

Another test that has actually been available for a long time is measurement of serotonin level. We can measure a metabolite of serotonin in the cerebral spinal fluid, but most people would not want us to do this because of it requires a spinal tap, or lumbar puncture. There are other ways to get this information, indirectly, as Dr. Seigle mentioned, by way of functional MRI scanning or PET scanning.

The problem with these tests, however, is that they are extremely expensive. In the US, governmental insurance programs such as medicaid and medicare are not willing to pay for these tests and a good portion of the severely and persistently mentally ill population who have insurance have the governmental program.

The practice of psychiatry is both science and art. Psychiatrists have to listen very carefully to what patients say and to what they don't say, take in the patient's body language, and often get information from sources close to the patient in order to make a diagnosis. Diagnosis is not a simple matter at all--especially considering that the psychiatrically ill brain cannot possibly analyze itself and report objectively to a physician.